Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2134 | CO |
Y | 103TC0700X | Clinical Psychologist | 2134 | CO |
NPI | 1013022581 |
---|---|
Provider Name | Dr. Heidi Cover Nahum |
First Address | Castle Rock, CO 80109-3130 |
Second Address | Castle Rock, CO 80109-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03327345 | (05) | CO |
513540 | VALUE OPTIONS (01) | CO |